Professor Colin Pritchard, Senior Lectures Jill Davy & Richard Williams, Centre for Social Work & Social

Policy, Bournemouth University

• Who Kill Children? Re-thinking the Neglect-Abuse Continuum in the search for improved Protection of Children.

• Identifying the Psychiatric-Criminological-

• Child Protection Interface

Preamble: Challenging the Neglect to Abuse continuum

• “We should not be afraid of making judgements because being thought `judgmental’. • • The continuum of neglect into abuse, & at the extreme a dead child, the `tip-of-the-

iceberg’ of neglect, & deaths became indicators of Child Protection effectiveness but who actually kill children?

• Re-analysing previous research we re-think the neglect to abuse continuum, placing the problem in a socio-economic context, recognising child Neglect is poverty- related but poverty is Not related to violent deaths.

• Serious violence very rare & people who kill children, are `special’ & not predominately neglecting.

• Assailants’ problems Mainly `psychological/ criminological’ rather than socio-economic, though poverty makes a situation worse.

• The Brandon (Serious Case Review) Report 2009 validates the re-analysis!!!

• More accurate assessment in identifying `potential’ assailants would improve agency collaboration if the psychiatric-criminological interface was better understood & given greater weighting in risk assessment.

Statistical Rarity of UK Extreme Violence Rates per million [pm] 2006(WHO & Home Office Crime Stats 2008)

• Homicides All Age. 15-24. 25-34 Rates pm• E& W Males 0.0003% 0.0006% 0.0004% : 3 - 6 - 4• Female 0.0001% 0.0003% 0.0002% : 1 - 3 - 2• USA Male 0.0097% 0.0219% 0.0194% : 97- 219 - 194

• USA 2005 0.0025% 0.0034% 0.0038% : 25 - 34 - 38• Assume all England & Wales murders (114) peak age criminality 18-32 to

randomly find 1 murder need 1: 27,2315 men.• Based on Wessex 10yr study to find 1 Child murderer Male [19-42years]

1: 659,298 & Women [20-34 years] 1: 527,188.• Most violent Western country, USA, 1 murderer in 11,757 18-28yrs men• `Violence against person 1,000,000 in Eng & Wales but only 44,000

needed medical attention i.e 4.4% or 0.07% general population.• Prison Population, 82,000 27% Serious Violent Crime & Sex =0.18% of

general population. • Serious Violence statistically Rare

Good News: Combined Homicide & 33% Undetermined Deaths (? Under-reported abuse) in 22 Western countries 1974-2006 ?

rates per million and % change

• Country Babies (<1) Babies & Infants (0-4) • & Ranks 1974-76 v 2004-06 1974-76 v 2004-06 . • [3-1] USA 65 - 87 47 - 57 • change +34% +21% .• [12-2 ]New Zealand 25 - 54 23 - 32 • % change +116% +39% .• [10=-3] Scotland 28 - 41 16 - 22 • % change +46% +38% . • [4=-4=] Germany 62 - 38 35 - 22 • % change -39% -37% .

• [4=-15=]Eng & W 62 - 15 38 - 10 • % change -76% -74% .

• [21-21] Spain 6 - 4 5 - 3 • % change -37% -40% .• [7-22] Ireland 40 - 2 22 - 2 • change -95% -99% .

•

Relative Poverty (Income Inequalities top 20% v bottom 20%) & ALL CAUSES of DEATH of Child (0-14) in 20

Western World Countries: Implications[ see Handout]

• Countries DEATHS pm & Rank Rank Income Inequality

• 1] USA 6839pm 1 1 8.5 times

• 2] Portugal 5208pm 3 2 8.0 times

• 3. UK 5141pm 5 3 7.2 times

• 4 Australia 4924pm 6 4 7.0 times

• 5. New Zealand 5880pm 2 5 6.8 times

• 6. Italy 4318pm 10 6 6.7 times

• 17. Sweden 2900pm 19 17 4.0 times

• 18. Norway 3273pm 17 18 3.9 times

• 19. Finland 3233pm 18 19 3.7 times

• 20. Japan 2862pm 20 20 3.4 times

Correlating `Poverty’, & Baby (<1) ACD & Violent Deaths in 20 Western World countries

• All Causes of Death (<1) & Income Inequality Baby [<1] Rho= +0.7694 p <0.001 highly significant

• Possible or Actual Child-Abuse-Related Deaths

• Ill-Defined-Signs & Symptoms Rho=+0.4403 p <0.025 significant.• Accident & Adverse Events Rho=+0.3874 p <0.05 sig

• Homicides Rho= -0.0145 Not significant• Homicide & 33% Undetermined Rho = -0.0521 Not

significant.• Poverty NOT statistically linked to Violent Deaths!?!?!?!

Who Kill Children ? Initial 2year cohort study of mainly, Police

Records plus SSD data & Regional Suicide register (4% sample UK population )

• 1]Male Child Sex Abuser Types: 2year cohort n=374)• i] Sex Only (50%) no other crimes but against children.• ii] Multi-Criminal-Child-Sex Abusers (36%) more non-sex-crimes than sex

offences.• iii] Violent-Multi-Criminal-Child-Sex-Abuser (VMCCSA) (14%), i.e with serious

previous violence, ABH or GBH.• 2]Decade of Child Homicide ASSAILANTS in 4% UK sample• Child Protection- Psychiatric Inter-face• Within-Family (82%) • Mentally-ill-Mothers (MIM) 30%, Mentally-ill-Fathers (MIF) 15%; `Step-Fathers

Previous Violence (SFPV) • 15%, Mother CPP (MCPP) 22% (but 15% jointly charged S.father).• Extra-Family Assailants: 18% [Male] VMCCSA.

• Flawed Interpretation Concerned about mental health stigma, instead of focusing upon Frequency & Commonality of Offender focused on Dangerousness.

New `Realistic’ Analysis: Commonality of Assailants.Joint Charged CPR Mothers; Court decided Not main killer.

Numbers- Common Sense approach to Statistics

• Category No’s in General Decade of Ratio of Assailants

• Population: Assailants. Rates p.a. to Population • General Population• Men [19-42] 8.57mill 13 1.5pm 1: 659,298• Women [20-34] 5.267 mill 10 1.9pm 1: 527,188• Wessex Mentally Ill 22,165 • Fathers 4 30pm 1: 3,355• Mothers 8 92pm 1: 1,093• Wessex Mother CPP 723 2 277pm 1: 362• Wessex• Previous Violence• S/Fathers 1703 4 235pm 1: 425 • VMCCSA 98 5 5102pm 1: 20 • Combined 1802 9 499pm 1: 200

The Practice Question in Mental Health & Child Protection (NB Brandon Report 2009 Validates re-analysis?)

• Psychiatrist ask re psychosis’- `personality disorder’ pnts What’s happening with children?

• Social Workers should “Is there a mental health problem’ and “a history of violence?” If these questions had been asked Wessex child homicides halved.

• Wessex Results Validated by Brandon Report (2009) on Serious Case Reviews 40 Intensive cases 53% Domestic violence & 63% mentally ill parents!?!?!? Brandon’s focus Process Not CONTENT

• Challenge notion that Neglect & Abuse are a Continuum- Child homicide assailants problems Essentially Psychological/ psychiatric-Criminal not primarily socio-economic.

• Current Risk Assessment Protocols fail to give sufficient weighting to Psychiatric & Previous violence- the Commonality of killers – We AVOID getting information on `Fathers’??

• Issue is INTER-GENERATIONAL POVERTY = NEGLECT, rather than ABUSE, should be recognised as the Dominant Problem. Instead `Worst-Case-Scenario, leads to costly & unhelpful bureaucracy & loss of focus on protecting and reducing neglect of children.

• “Naught is good or ill but as thinking (The Media) makes it so” • Policy Should be Evidenced Not Media Driven

References (National Sources online: WHO (2008) Annual Statistics. Office National

Statistics (2010); Home Office (2008) Crime Statistics)

• Brandon Report (2009)Understanding Serious Case Reviews & their Impact. Dept CSF (Education)• Falkov A (1996) Fatal Child Abuse & Parenting Psychiatric Disorders. Part 8. London, Dept Health.• Pritchard C (2004) The Child Abusers: Research & Controversy. Open Uni Press. • Pritchard C & King E (2005) Comparison of Child-Sex-Abuse-related & Mental-Disorder-Related Suicide in

Six-year cohort of regional suicides: The importance of the Child Protection-Psychiatric Interface.British Journal Social Work. 34, 181-198

• Pritchard C & Sayer T (2007) Exploring potential `Extra-familial Child Homicide Assailants in the UK and estimating their Homicide rate: Perception of Risk & the need for Debate. British Journal Social Work. 36 in press.

• Pritchard C & Williams R (2009) Does Social Work Make a Difference? A Controlled study of Former Looked-After-Children and Excluded-from-School Adolescents Now Men Aged 16-24: Subsequent Offences, Being Victims of Crime and Suicide. Journal of Social Work 9, 285-307.

• Pritchard C & Williams R. (2010) Comparing possible child-abuse-related-deaths in England & Wales with the major developed countries 1974-2006. British Journal of Social Work. 40, 1700-1718

• Wilkinson R & Pickett K (2009)  Spirit Level.Why more equal societies almost always do better. London, Allen Penguin.MUST

• Williams R & Pritchard C (2006) Breaking the cycle of educational disadvantaged. Open Uni press